Ch 1 TI Summary.pdf

1.2 Foundational Concepts therapeutic exercise systematic, planned performance of physical mvmnts, postures or activities intended to provide a pt/client w the means to “prevent impairments and maintain or improve fxn” 1. could mean to improve, restore or enhance activities & participation 2. can...

1.2 Foundational Concepts therapeutic exercise systematic, planned performance of physical mvmnts, postures or activities intended to provide a pt/client w the means to “prevent impairments and maintain or improve fxn” 1. could mean to improve, restore or enhance activities & participation 2. can prevent or reduce health related risk factors thru therapeutic exercise 3. optimize health, fitness and well being for pts pt an individual w impairments and fxnal deficits diagnosed by a PT and is receiving physical therapy care to improve fxn and prevent disability client an individual w/o diagnosed mvmnt dysfxn who engages in physical therapy services to promote health and wellness and to prevent dysfxn benefits of exercise beneficial across physiotherapy practice *place holders for various diseases and dysfxns that ther inter can positively affect 1. MS 2. knee osteoarthritis 3. Getting There chronic low back pain 4. heart disease 5. heart failure 6. obstructive pulmonary disease components of fxn • ability to move is dependent on psychological, social, and physical fxns • these are interrelated types of exercises safety acccording to the World Health Organization, safety aims to prevent and reduce risks, errors and harm that occur to pts during the provision of health care “pt safety… is paramount .. dare of the therapist also must be considered , particularly when the therapist is directly involved in the application of an exercise procedure or manual technique summary 1. Therapeutic Exercise is the systematic, planned performance of physical movements, postures, or activities intended to provide a patient/client with the means to” prevent impairments and maintain or improve function. 2. There are numerous types of and benefits to exercise which are heavily supported in the literature. 3. Safety is a foundational component of exercise prescription. 1.3 Mechanotransduction Mechanical Therapy: physiological process of tissue adaptation easy definition how the body converts mechanical loading into cellular response • • - influences regeneration/growth (modeling/remodeling) OUTCOME: viable tissue with specific fxn that changes depending on demand • how body changes to stimulus as PTs • primary way to treat pts • every intervention includes mechanical loads ex: joint mobs, strength training, stretching, PROM, dry needling, shockwave therapy 2 laws of mechanotherapy 1. Davis Law : how SOFT TISSUE changes according to demands 2. Wolffs Law: how OSSEOUS structures change according to demands Cell types that respond to mechanical stimulus • osteocytes • chondrocytes different depending on magnitude, • fibroblasts durations, frequency • keratinocytes • stem cells Examples • endothelial cells: respond to shear stresses of BF • lungs: rarely respond to tension caused by expansion/reduction of air vol • bones: compression/distraction forces How do cells respond to stimulus • mechanosensitive receptors in cell walls - ion channels, integrins, growth factor receptors • cell bodies have focal attachments to other cells that transmit forces across the membrane - influences proliferation, differentiations, migration Primary Cilium • • pivotal in mechanotransduction! detect/transmit extracellular cues to regulate cell process in homeostasis - maintains cell health/fxnal change Mechanotransduction alters genetic expression leading to • cellular proliferation • migration • tissue repair • altered metabolism • stem cell differentiation Getting There Disease Processes 1. changes in cell mechanics 2. altered cellular matrix structure 3. deregulation of molecular mechanisms 4. affects a wide range of diseases included in all fields of medicine Why do diseases occur? • altered mechanical transduction capabilities of cells Getting There Application of Mechanotherapy important to know in order to modify POC according to biological response to interventions • Consider • compression/distraction of bone • force on cartilage • tension on Muscles, tendons and skin Example: Osteoporosis • prolonged immob, sedentary lifestyle, genetics result in decreased bone mass • Contraindications: jumping, high load activities Duchenne Muscular Dystrophy • autoimmune disease with excessive inflammatory processes Summary • cells are preset to respond to mechanical stimulus • mechanical forces are transmitted from cell to cell and mediate • a fxnal change at the level of the cell through genetic expression • responsiveness in cells can be altered by disease processes • PT can use the forces to affect mechanotransductive related diseases 1.4 ICF of Disability and Health ICF definition a biopsychosocial model where environmental factors and personal factors are integrated into the concept of fxning and disability international Classification of Disease aka ICD classifies diseases • together they prove a broader and more meaningful picture of health of both individuals and populations worldwide ICF • intends to classify subjective health and health related states • related to health and fxn experienced by ALL ppl • is grounded in a model that aims to ascribe an interconnection bw biology, psychology and socioenvironmental factors ICF Overview fxning characterized by positive interactions that are defined by the integrity of body fxns and structures & the ability to perform activities and participate in life situations disability characterized by negative integrations of health situations defined as impairments and body fxns and structures, activity limitations and participation restrictions contextual factors relevant background info on an individuals life and living situation environmental factors make up the external, physical and social circumstances that a person lives in personal refer to internal processes that influences fxn and disability be familiar w these q’s ICF Model Application to PT 1, methodology of personalized care 2. ICF is fundamental on how we as PTs can prevent disability in our pts • classification • treatment • prevention 1. Primary: activities such as health promotion designed to prevent disease in an at-risk population 2. secondary: early diagnosis and reduction of severity or duration of existing disease and sequelae 3. tertiary: use of rehab to reduce the degree or limit the progression of existing disability and improve multiple aspects of fxn and persons w chronic irreversible health conditions risk factors 1. biological 2. behavioral, psychological and lifestyle factors 3. lifestyle characteristics 4. socioeconomic factors modifying risk factors thru intervention like therapeutic exercise is an • important tool for preventing/reducing impact of health conditions and subsequent impairements, activity limitation and participation restrictions associated w disability • risk factors are influenced or characterized by a certain set of predispositions a person has, that won't impair their fxn or potentially cause them a disability. they exist prior to the onset of a health condition and associate impairments, limitations or restrictions.- - primary prevention. • When a health condition exists, the reduction of risk factors by means of an any intervention that reduces the impact or progression of a pathological condition is appropriate- - secondary or tertiary prevention. summary 1. The ICF model is “…a biopsychosocial model where environmental factors and personal factors are integrated into the concept of functioning and disability.” 2. The model provides a construct for the classification and treatment of our patients, while also giving us the means to prevent future dysfunction by controlling for risk factors 1.5 Principles of Patient Management Clinical Decision Making PT use base knowledge of • accessibility • relevance • completeness • reliability • critical thinking • & experience all to make an actionable strategy! Primary practioners • co-management • consultation • supervision • referral share responsibility of pt seek/provide professional expertise regarding presentation of condition that falls out of scope or ones unfamiliar with delegate part of TX understanding/application of EBP provide foundation to guide PT through decision making process • Includes the integration of best available evidence, clinical expertise, & pt values & circumstances related to pt and client management, practice management, and health policy decision making management principles model 1. examination 2. evaluation 3. data collection determination based on impairments/bodt structure diagnostic impression fxn of individual/activity limitations resulting in mvmt dysfxn 4. prognosis POC based on obj & pt goals 5. intervention 6. outcomes Repeat! aimed to improve pt fxn health-related QOL • reduces risk factors for disease, injury, impairments summary • pt management model offers a comprehensive and systematic approach to offerings of effective PT • Getting There system emphasizes care that reduces risk factors for disease, injury & impairments while promoting health in our pts 1.6 Motor Learning Basic Principles motor learning a complex set of internal processes that involved the acquisition and relatively permanent retention of a skilled mvmnt or task thru practice basic concepts motor performance- infers an ability motor learning- developed and crossover bw one mvmnt pattern into other fxnal mvmnt patterns a pts ability to perform an activity early in the learning process is not representative of having a retain the skill or learned it, which we would call retention or retaining. motor learning tasks 1. discrete : action w a distinct beginning & end 2. serial : a series of discrete mvmnts combines into a specific sequence of action 3. • continuous : action w no specific beginning or end it has repetitive, uninterrupted mvmnts w an arbitrary start and stop point motor learning taxonomy • desired outcome of the action - developed to help analyze the complexity of mvmnts and how we can use individual components of activities to increase or decrease the associated complexity of an activity ex: open environment and/or moving bodies- more complex motor tasks of daily life 3 stages of motor learning 1. cognitive stage- learning: associated w thinking or learning about components of a skill and getting the feel of a skill 2. associative stage- refining: refining what we know; consistency, improved efficiency, can modify performance and can do in diff environments; will need less feedback and can self correct 3. autonomous stage-automatic: task or skill is performed without any attention and personal can multitask or execute w varying tasks or environmental demands summary 1. Complex set of internal processes that involves the acquisition and relatively permanent retention of a skilled movement or task through practice. 2. 3 distinct types of tasks a. Discrete b. Serial c. Continuous 3. 3 stages of motor learning a. cognitive b. Associative c. autonomous 1.7 Motor Learning Application Environmental Conditions 1. closed environment (controlled) • with variability • without variability Ex: surrounding obj stable Why? • more focus • self pacing • predictable 2. open environment (uncontrolled) • with variability • without variability variability - changes in the task from one to another Ex: surrounding unstable • more = complex motor learning Why? • increases speed of skill acquisition • unpredictable • loss of control • more challenging as clinician important to understand • purpose • goal • attention practice: most significant variable in teaching a new task to a pt Practice Types best together, practicing mentally prior reinforces physical practice (enhances retention/increased skill aquisition • mental/physical • part/whole practice discrete mvmt patterns • practice order entire task completed from beginning to end more difficult, better for continuous skills blocked :skill practiced repeatedly then new skill random :random skills practice for time before changed in a session • promotes skill retention/generalizability of skills bc needs more cognitive effort • motor learning!! feedback = sensory info to use to perform motor skill (most important) 1. intrinsic 2. extrinsic 3. timing 4. qualitative early learning = constant feedback variability = skill retention, later ex: slow down, focus on moving body this way 5. quantitative ex: last time did this many, timing extra: use delayed feeback instead of physical cue bc it prompts intrinsic feedback factors for adherence • patient related : belief/attitude • health conditions: severity/chronicity of health condition, pain etc • program: too complex, meeting goals, therapeutic alliance? summary: promoting environmental variability in exercise important altering task can promote adaptability and pt success facilitate learning by determine the appropriateness for a task based on cognitive level. complexity of task, type of practice and feedback Synchronous Session One Faculty Name PT, PhD Jeffrey Foucrier PT, DPT Orthopedic Clinical Specialist Week One Physical Therapists as skilled medical providers. 1. Foundations: 1. Patient vs Clients 2. Components of Function 3. Exercise 4. Safety 2. Mechanotherapy 3. ICF (Review) 4. Patient Management (Review) 1. Clinical Decision-Making 2. Roles 3. Management Model 5. Motor Learning Theory and Application (Review) Activity: True/False - Mechanotransduction Mechnotherapy is the process by which the body converts mechanical loading into a therapeutic cellular response. helps w/ recovery// how body heals True / False Davis and Wolff’s Laws are examples of Mechanotransduction? True/False Activity: Waterfall - Mechanotransduction any time we manipulate tissue = mechanotransduction What structures are thought to be involved in mechanotransduction? • <Enter Text Here> • mmt • strengthening • manual therapy • traction • estim What is one cell structure that is thought to respond to mechanical stimuli? • <Enter Text Here> primary cilium any tissue built to resist/ work in force even neuro system ex: skin, skeletal, cardiovascular What are the physiological effects of mechanical stimuli on tissue? • <Enter Text Here> tissue adaptation genetic expression Activity: Discussion – ICF Model What questions does the ICF model hope to answer from a clinical standpoint? how condition is impacted by their life how a pt may react to therapy What is the relationship between the ICD and ICF models? ICD - how we diagnose, more biological ICF - talks about social, environmental components Activity: Matching – Levels of Preventative Care 1. Primary a) no disease! 2. 3. Use of rehabilitation to reduce the degree or limit the progression of existing disability and improve multiple aspects of function in persons with chronic, irreversible health condition. Secondary b) Activities such as health promotion designed to prevent disease in an at-risk population. c) Early diagnosis and reduction of the severity or duration of existing disease and sequelae. Tertiary no disease to oh shit pt is diseaseddd i’m just quizzing myself hehe oh shit same 2. c and 3 is a ill write reasons and u write answer? i need to quiz on these bc my brain cant think that fast Activity: Label – Levels of Preventative Care p 1. Taking vitamins: 2. Having a mammogram: 3. Altering risky behaviors: 4. Blood pressure testing: 5. Movement screen: 6. Chemotherapy: 7. Dry needling: 8. Influencing policy and procedure: 9. Community education: t prevention s identifies a disease process p preventing disease s s t treats myofascial problems p p Activity: Discussion – Risk Factors What does this Box remind you of? dumb q but what is intertrial variability again? Activity: Discussion – Motor Learning Taxonomy 1. What 4 factors affect motor learning demands for any one task? environment stable/moving closed no object moving obj manipulation no body mvmnt variability 2. Identify the following according to motor learning taxonomy. intertrial variability Give an example of each. 1. Factor One: 2. Factor Two: 3. Factor Three: 4. Factor Four: open: no control of environment closed: controlled intertribal variablility manipulation: adding another obj body mvmt Activity: Roleplay – Educate Dr. Stern on the Following Concepts 1. Part Practice when you take a task and break it up into parts Dr. Stern asks you the following questions as it relates to his clinical care: What type of practice is BEST for: break it down 2. Whole Practice • part/blocked do entire task motor learning??? 3. • Block Practice focus on one specific task within set period of time, nothing else • motor learning Skill retention? random Random Practice change task between each task within a set time Learning continuous skills? whole motor performance 4. Early learning? • Fast skill acquisition? random: challenging neuromuscular system Activity: Case Application Instructions: After watching the patient video (below), please select one task to train with the patient. Within the context of Motor Learning Taxonomy, Stage of Learning, Types of Practice and Feedback: • What information do you want from the patient to help the interventions to be most effective? • What type of task are you training? • Define the parameters (demands) of the task by completing the environmental conditions grid. Be prepared to offer recommendations for feedback and type of practice. Case Video Study Point: Don’t forget to review the following. Know the definition and application of each of these concepts:     Discrete Actions Serial Actions Continuous Actions Stages of Motor Learning: Cognitive, Associative and Autonomous.